1. Improving Mental Health Services in Bristol
Andy Sylvester – Executive Director of Operations 1

2. Welcome and introductions
Housekeeping
Format of the day
Presentations
Questions and answers
Information stalls: find out more and meet our staff
What happens next

3. Bristol context NHS Bristol tender Relationships
AWP want provide strong, local, responsive services
Striving to improve local confidence
Service changes demonstrate how we can meet expectations

4. The need for change Bed numbers Old service models
Variations in service user experience and outcomes
Value for money, improved quality and outcomes

5. AWP’s vision for Bristol
Strong service users and carer engagement
Improved accessibility through your GPs
Locally managed, responsive services
Greater choice of community support
Operate above nationally recognised standards

6. Benefits: service users and carers
Improved care co-ordination through regular review, taking account of individual needs
Equal access to services
Easier access to the right services, with the right specialist staff at the right time
Recovery focused services

7. Presentations
Liaison and later life services – Roger Bullock, Clinical Director
Community services – Justine Faulkner, Clinical Director for adult acute community services & colleagues
Rehabilitation Services – Carol Bowes, Acting Service Director for specialised & secure services
Adult inpatient services – Andy Johnston, Clinical Director and Mark Bunker, Consultant Nurse, for adult acute inpatient services

8. Liaison and later life services in Bristol
Roger Bullock – Clinical Director 8

9. Liaison and later life Liaison Front door for specialist services
Helping other providers of care perform their work (particularly primary care, acute hospitals and care homes). No health without mental health
Promoting mental health – no thresholds
Working in a preventative way alongside social care
Signposting and direction
Achieving independence
Front door for specialist services

10. Liaison and later life..2 Later life
Age-appropriate specialist psychiatric and psychological therapies
Dementia services
Memory clinics
Community based complex intervention teams
Inpatient

11. Who and where All services are based from Callington Road Hospital
Liaison
Led by Alyce Chappell
Team comprises 16 nurses and Dr Andrew Brindley with admin support
Runs 8.00 am to 8.00 pm Monday-Friday and Saturday morning
Later Life
Community services led by Gina Lang (9.00 am to 5.00 pm)
Inpatient services (Aspen and Laurel wards) led by Mandy Taylor
Memory services led by Claire Morley (9.00 am to 5.00 pm)

12. Aims of Bristol’s liaison & later life services
Flexibility
Early assessment at GP surgery, local clinic, at home, in hospital or in a care setting
Local emphasis, integrated with family care – no thresholds or bureaucracy
Problem solving approach rather than diagnosis based
Speed
Rapid response to requests for advice and quick access to specialist community based complex intervention team for ongoing care and support where needed

13. Aims of Bristol’s liaison & later life services
Expertise
Provision of specialist therapeutic support and treatment from occupational therapists, physiotherapists, psychologists, psychiatric nurses, consultant psychiatrists and other staff.
Access to specialist inpatient care at Callington Road Hospital
Collaboration
Mental health is not an isolated issue
Specialist mental health support and advice to GPs, Bristol Community Health and social care staff and any other staff caring for older people with frailty, mental health and cognitive disorders
Clear pathways, with delegated roles and responsibilities to ensure people do not get ‘bounced around’

14. Current issues
Historically too many inpatient beds provided in Bristol
Need for more community based staff to meet the demands of an ageing population
Need an integrated approach with older people’s services and social care – including using personalised care to full advantage

15. Current issues..2
Need to manage the increasing numbers of people requiring a memory assessment
Need to be part of a comprehensive multi-agency dementia pathway
Need to increase confidence and capacity in primary care to meet some of the needs of older people in the surgery rather than specialist settings

16. Planned changes
No longer providing inpatient beds for older people at Southmead Hospital will release existing resource to further invest in our plans for improving services in Bristol
More comprehensive and therapeutic community-based services will be delivered including expanded memory, liaison and support to people in care homes
Consolidation of high quality, specialised inpatient services in one location in Bristol (Callington Road Hospital) also means on-site access to the full range of community and therapeutic support services

17. Planned changes..2
Increased partnership with GPs and Bristol Community Health to look after people with a variety of mental health and cognitive problems in the primary care setting and only using secondary specialist mental health services when needed
Fully exploit the advantages of primary care liaison alongside Bristol Council to help promote mental wellbeing in the city

18. Benefits Preventative approach Early intervention and diagnosis
GPs, social care and other staff looking after people with dementia and mental health difficulties will get better support from specialist nurses and doctors to allow people to get the help they need more quickly
Early intervention and diagnosis
Will enable people to be aware and understand their problems at an earlier stage of their illness, allowing more choice and control over what happens in their treatment journey

19. Benefits..2 Meeting need through building capacity
Development of expanded and comprehensive community services will help more older people to continue to live at home by providing the care that is needed with high quality therapeutic, practical and intensive support
Offering help in the right place
Shifts the emphasis from hospital and institutional forms of care to the provision of services that meet the needs of service users and carers in their own homes or in an environment that optimises their abilities to live independent and fulfilling lives

20. Modernising mental health services in Bristol
Five themed objectives:
Have a locally accountable Bristol structure
Ensure greater partnership and interface working
Provide clearer routes into and services that are easier to access
Provide dementia as a distinct care pathway
Have prevention and early intervention as the default position

21. Improving Mental Health Services in Bristol21

22. We heard what people were telling us and….
Restructured our teams
Talking therapies available as a matter of routine
Re-selected 600 staff
Set up new training pathways to ensure all are highly skilled
Made sure that all teams have drugs and alcohol expertise

23. Our teams Primary care liaison service - the front door Intensive team
Recovery teams
Early intervention team
Psychological therapies service
Vocational service

24. The Bristol intensive team
Formerly known as crisis resolution and home treatment teams (CRHT)
Multidisciplinary team of more than 35 staff
Drs Sarah Oke and Susanne Wille – consultants
Holly Starkey, Tony Bohanna +2 (Senior pracs/managers)
Based at Colston Fort
Operate 24/7, 365 days a year
Contact us on

25. The Bristol intensive team - what we do
Home treatment: two to three times a day visits as an alternative to admission for very unwell and high risk service users
Diagnose, prescribe, dispense and supervise medication
Interventions – counselling, CBT, practical support, psycho-education, carer support etc
Also provide:
All four hourly crisis assessments
Gatekeeping all admissions
Bed management and early discharge from hospital

26. The Bristol intensive team - out of hours service
24 hour home treatment visiting at night in patients’ homes
24 hour crisis assessments in places of safety, police stations, service users’ homes and in A&Es (BRI and Frenchay)
Cover other teams (primary care liaison(PCL), recovery, early intervention etc and out of hours PCL). Crisis service only.
Support night shift junior doctors

27. The Bristol recovery teams
Three teams in Bristol
North Gloucester House, Southmead Hospital
Contact:
Central Brookland Hall, St Werburghs
Contact:
South Petherton Resource Centre, Hengrove
Contact:
The teams will operate flexibly between 8.00 am and 8.00 pm Monday to Friday

28. The Bristol recovery teams - what we do
Provide ongoing assessment and multidisciplinary specialist interventions
Service will be offered to any one who has been assessed by primary care liaison service or the intensive service as requiring ongoing treatment from specialist mental health services

29. The Bristol early intervention in psychosis team
City wide service based at Colston Fort, Kingsdown
The multidisciplinary team includes:
Team manager, psychologist, consultant psychiatrist, clinical development lead, care coordinators (including CPNs, occupational therapists, social worker), non-medical prescribers, support workers, sports worker as well as administrative support

30. The Bristol early intervention in psychosis team
What we do
Team works directly with people aged 16 – 35. For young people aged 14 – 16 we work in partnership with child and adolescent mental health services
Referrals can be from any source, although most come from GPs
Assess anyone meeting the age criteria who has symptoms of psychosis (hearing voices, paranoia, disordered thinking) or where there are concerns that this may be developing

31. The Bristol psychological therapies service
The Bristol psychological therapies service (PTS) is one overall team serving the whole area.
Head: Shane Matthews, consultant clinical psychologist
Staff background: clinical and counselling psychologists, nursing, art psychotherapy, medicine.
Our hours of operation will be where possible 8.00 am to 8.00 pm in Gloucester, Brookland Hall, Petherton and Callington.
Contact us at Petherton Resource Centre

32. The Bristol psychological therapies service
What we do
Support the new teams by offering consultations to help with assessment and treatment decisions and the supervision of psychological interventions which the teams carry out
Directly provide where appropriate psychological interventions for complex cases such as clinical psychology formulation and intervention, CBT, brief psychotherapy, family work, etc

33. Questions and answers 33

34. Improving specialist services Carol Bowes – Service Director
Rehabilitation services
Eating disorder inpatient services
Eating disorder primary care services
Specialist learning disability inpatient service for people suffering from a mental illness

35. Rehabilitation services
Rehabilitation services provided in Bristol are for:
Hospital based resettlement services, bringing people back from out of area placements
Hospital based rehabilitation
Community based rehabilitation
In December 2011, the temporary closure of one of the community based units, Lodge Causeway, resulted in bed numbers falling from 41 to 30

36. Why change?
Rehabilitation beds were underutilised - across all the units, bed occupancy averaged 60%
Occupancy in community units was 10% lower (50%)
Pooling resources into a single community based ward meant we could improve the interventions made available to people using the service

37. Why Lodge Causeway?
The other community based unit, Blaise View, had better safety infrastructure, such as an alarm system
Blaise View was more compliant than Lodge Causeway with the Disability Discrimination Act
Lodge Causeway did not meet the single sex accommodation requirements to the same standard as Blaise View
Although Blaise View is a community based service, support is immediately available during office hours from another AWP building next door
Lodge Causeway provided respite accommodation, which was not formally requested by the PCT, and could be maintained within other units

38. What next?
As the temporary closure of Lodge Causeway has not prevented anyone from receiving rehabilitation care when needed, we believe this closure can be made permanent
Care coordinators and NHS Bristol are working together to understand how best to provide respite care that meets individual needs. A single type of provision, such as a bed within a community rehabilitation unit, cannot meet all needs

39. Eating disorder inpatient services
Background
Inpatient eating disorder services in Bristol were provided in an annex of an acute ward at Southmead Hospital
This provided six beds for use by people in Bristol, B&NES, North Somerset and South Gloucestershire
People were regularly sent out of area as these six beds were not sufficient to meet the needs of these areas
In autumn 2011 we were told that inpatient eating disorder beds would be commissioned through the NHS Commissioning Board and would need to comply with a national specification

40. Eating disorder inpatient services
Proposal
The national specification was not met by the annex service we were providing
We already knew that six beds were not sufficient to meet the needs of the PCT areas
What we did
Identified space on the Southmead site where we could operate a 10 bedded specialist eating disorder inpatient service
Worked to get this specialist service operational from April 2012
Opened the NEW service in April 2012, providing care that meets the national specification for up to 10 people at any one time

41. Eating disorder primary care services
In 2011 we started a pilot project for a primary care eating disorder service for Bristol University
This service has been very well received and we are now working with NHS Bristol on how it can be expanded across the city
This would mean the service working from three primary care bases within Bristol opening up access to the service to the whole Bristol population

42. Specialist learning disability inpatient service
The Lansdowne assessment and treatment unit admits people with learning disabilities and mental health problems whose needs cannot be met within mainstream mental health services
This service is used primarily but not exclusively by people from the Bristol area

43. Specialist learning disability inpatient service
This service is currently provided in a 12 bedded unit based on the Blackberry Hill site
The current environment does not meet the best practice guidance for this type of service, nor is it fully compliant with CQC standards
Proposal
To relocate the service to an environment that fully meets best practice guidance and is fully compliant with CQC standards
To achieve this through redesigning an empty ward on the Southmead site and relocating the service

44. Review of inpatient service redesign and impact assessment
Mark Bunker - Consultant Nurse Andy Johnston - Clinical Director 44

45. What have local people told us?
Focus on people’s recovery and strengths
Service user and carer involvement in planning
Be socially inclusive and help people stay in touch with home, family, work - a meaningful life
Provide better information
Integrated, prompt assessments and where possible, through a single point of access
Equitable, fair, person-centred and flexible
Clear pathways of care into, out of, and in between services

46. Current services – adult inpatients
15 acute beds – Weston Ward, Southmead Hospital
19 acute beds – Lime Ward and Silver Birch Ward, Callington Road Hospital
8 HDU beds – Mason, Southmead Hospital

47. Proposed adult inpatient model of care
52 adult acute inpatient beds
19 Silver Birch Ward, 23 Lime Ward, 10 Weston Ward
A reduction of one acute inpatient bed
No HDU beds
A reduction of eight HDU beds and re-patterning the four HDU beds on Lime Ward into Acute beds through transferring the four acute beds from Weston Ward to Callington Road as part of the Southmead project

48. Quality improvement initiatives
Productive Ward programme
National quality Acute Inpatient Accreditation Programme (AIMS)
Silver Birch: accredited as ‘Excellent’
Lime: awaiting Royal College of Psychiatrists award
Clinical handover initiative developed by Lime Ward
Completed ‘Missing Persons’ action plan, complied with AWOL clinical performance targets and improved clinical management
Physical healthcare clinics on wards for wellbeing/health promotion
Completing improving therapeutic approaches pilot using a solution focused approach
Recovery approaches to care and treatment on all wards

49. Quality improvement initiatives..2
Developed and embedded a clinical lead nurse role for safety and compliance to ensure learning from incidents, events and feedback
Life cycle environmental improvements completed in some areas and work to improve other environments underway
Weekly care pathways meetings assist reviewing service users progress and ensuring the right service is being delivered
Performance management framework being used to effect the attitude, motivation and opportunities of our workforce
Developing a new ‘welcome and hospitality facilitator’ role for each ward having listened to service user feedback
Recovery Star used to promote recovery approach for service users
New service user feedback initiative called VOICE

50. Leadership improvement initiatives
Established New nurse consultant and medical lead consultant psychiatrist posts in Bristol
Consultation about to begin on new clinically focused roles for modern matrons and ward managers
Delivering development programme for all Band 6 team leaders throughout the inpatient services
Designed a matrons MasterClass programme
Monthly peer supervision programme for matrons
Matron development away days to support cross learning
Bespoke training pathways for staff across the inpatient services based on core competencies
Medical leadership coaching programme

51. Questions and answers 51

52. Improving Mental Health Services in Bristol
Andy Sylvester – Executive Director of Operations 52